Complications and Risk Assessment of 25 Years in Pediatric Pacing

Children who require cardiac pacemaker implantation have presented a small patient sub-population since the breakthrough of this technology in the 1950s and 1960s. Their small bodies result in a technical challenge for the operating surgeon and put the patient at risk for a series of specific complications. Our study aims to analyze complications and to identify risk factors of endocardial and epicardial pacemaker systems in children.

All pacemaker-related operations in pediatric patients up to the age of 18 years from 1985 through 2010 were retrospectively evaluated. Demographic data including age, height, and weight were recorded. Idiopathic and postoperative dysrhythmias were analyzed separately.

A total of 149 pacemaker operations were performed in 73 patients. Thirty-two patients did not have a previous cardiac operation. Indications for revision included box exchange, lead-related problems, pacemaker pocket complications, impaired left ventricular function, and pectoral muscle stimulation. Increased pacing thresholds occurred in 17.2% of the patients with epicardial leads compared with 2.9% in the endocardial group. Aside from threshold-related revision, lead problems are more common in the endocardial group (30.4% vs 17.2%). Venous thrombosis occurred in 13.7% of the patients (only endocardial), preferentially (25%) in the weight group less than 15 kg and in idiopathic patients (15.6% vs 10.5% with prior cardiac surgery).

Cardiac pacing is particularly challenging in the pediatric patient population facing a large number of reoperations during their lifetime. The lack of clear superiority of either epicardial or endocardial pacing systems requires an individual concept.